65 YEARS MALE WITH RIGHT INDIRECT INGUINAL HERNIA, ACUTE ISHEMIC STROKE WITH RIGHT HEMIPERASIS, ATRIAL FIBRILLATION WITH CONTROLLED VENTRICULAR RATE /C/O HTN, T2DM.

 CHIEF COMPLAINTS :
SWELLING IN RIGHT INGUINOSCROTAL REGION SINCE 4 MONTHS 

HISTORY OF PRESENTING COMPLAINTS :
PATIENT WAS APPARENTLY NORMAL BEFORE 4 MONTHS, SUDDENLY HE DEVELOPED SWELLING IN RIGHT INGUINOSCROTAL REGION INITIALLY IT IS 3×2 cm, GRADUALLY PROGRSSED TO PRESENT SIZE 
NO H/O FEVER, COUGH, COLD
NO H/O VOMITINGS, DIARRHOEA, CONSTIPATION 
NO H/O BURNING OR DIFFICULTY IN MICTURITION.

PAST HISTORY :
NO H/O SIMILAR COMPLAINTS IN THE PAST
H/O APPENDICECTOMY DONE 20 YEARS AGO 
K/C/O HYPERTENSION, DIABETES MELLITUS SINCE 5 MONTHS
N/K/C/O. TB, ASTHMA, EPILEPSY, THYROID DISORDERS.
TREATMENT HISTORY:
ON TAB.TELMA 40 mg, OD, TAB. GLIMI. M1 OD SINCE 5 MONTHS

PERSONAL HISTORY: 
Diet - mixed 
Appetite - normal 
Bladder - normal
Bowel - regular
Sleep - adequate 
. No h/o Alcohol intake
No h/o.Smoking
No drug addictions 

FAMILY HISTORY:
No H/O HTN/DM/TB/ASTHMA/EPILEPSY/CAD/THYROID DISORDERS in the family.

PROVISIONAL DIAGNOSIS 
RIGHT INDIRECT REDUCIBLE INCOMPLETE INGUINAL HERNIA

GENERAL PHYSICAL EXAMINATION:
HEIGHT - 175 cms
WEIGHT - 77 kg
NO PALLOR 
NO ICTERUS 
NO CYNOSIS 
NO CLUBBING 
NO LYMPHEDNOPATHY 

DAY 1 ON EXAMINATION: 04/07/2025 
TEMP - 98.1 f
PULSE - 78/min regular
BP - 130/80 mm of hg
RR - 20 / min
SPO2 - 98% on RA 
CVS -S1,S2 PRESENT, NO MURMURS 
RS - BAE -PRESENT , NVBS 
PA - SOFT , NON TENDER 
CNS - NFND 
GRBS - 101 mg/dl 
LOCAL EXAMINATION :
ECG ON 04/07/2025
2D ECHO
https://youtube.com/shorts/FvLaQR58dAk?si=861HDLKFpB5QLkuX

Mitral Valve: Mild MR
Tricuspid Valve: Normal
Pulmonary Valve: —
Aortic Valve: Calcified AV
Right Atrium: Dilated
Right Ventricle: Normal
Left Atrium: Dilated
Left Ventricle: Dilated + RWMA(*) LAD Territory Hypokinesia, Mild LVH(+)

  • ESD: 4.4 cms
  • EDD: 5.8 cms
  • DPW: 1.02 cms
  • EF: 47%
  • FS: 24%

IAS: Intact
IVS: —
Aorta: 2.0
Pulmonary Artery: —
Pericardium: —
IVC/SVC/CS: IVC size (1.04 cms) collapsing
Pulmonary Veins: —
Intra-Cardiac Masses: Nil
Others: —

DOPPLER STUDY:

  • Mitral Flow: E > A
  • Aortic Flow: 1.62 (AR-PHT - 560 ms/sec)
  • Pulmonary Flow: 0.9
  • Tricuspid Flow: Rvsp 49+10 = 59 mmHg

Moderate TR / CPHT / Moderate MR / Mild AR / Trivial PR

COLOUR FLOW MAPPING:

RWMA(*) LAD Hypokinesia, no clots, calcified AV
Mild LV dysfunction (+)
Grade I Diastolic dysfunction / no PE / no LV clots


INVESTIGATIONS ON 04/07/2025
TREATMENT ON 04/07/2025 
NORMAL DIET
TAB. TELMA 40MG PO OD
TAB. GLIMI M1 PO OD
TAB. PAN 40mg PO. OD
TAB. MVT. PO. OD

DAY 2 ON EXAMINATION: 05/07/2025 at 8am
TEMP - 98.2 f
PULSE - 78/min regular
BP - 130/70 mm of hg
RR - 16 / min
SPO2 - 98% on RA 
CVS -S1,S2 PRESENT, NO MURMURS 
RS - BAE -PRESENT , NVBS 
PA - SOFT , NON TENDER 
CNS - NFND 
GRBS - 101 mg/dl 

DIAGNOSIS :
RIGHT INDIRECT REDUCIBLE INCOMPLETE INGUINAL HERNIA WITH OMENTUM AS HERNIATING CONTENT
K/C/O HTN, T2 DM
ECG ON 5/7/2025
INVESTIGATIONS:
TREATMENT ON 05/07/2025 at 8am
NORMAL DIET
TAB. TELMA 40mg. PO OD
TAB. GLIMI M1 PO OD
TAB. PAN 40 MG PO OD
TAB. MVT PO OD
PATIENT REFERRED TO DEPARTMENT OF GENERAL MEDICINE I/V/O WEAKNESS OF BOTH UPPER AND LOWER LIMBS AND ECG CHANGES. PATIENT HAS BEEN TAKEN OVER BY DEPARTMENT OF GENERAL MEDICINE ON 6/7/25.

DAY 3 ON EXAMINATION: 06/07/2025 at 8am
TEMP - 98.1 f
PULSE - 82/min irregularly regular
HEART RATE = 100/min
APEX PULSE DEFICIT - 18
BP - 140/80 mm of hg
RR - 20 / min
SPO2 - 98% on RA 
CVS -S1,S2 PRESENT, NO MURMURS 
RS - BAE -PRESENT , NVBS 
PA - SOFT , NON TENDER 
CNS - NFND 
GRBS - 130  mg/dl 

https://youtube.com/shorts/nwb_Spvb18U?si=K_Y3OnTlbNlegtyv

DIAGNOSIS ON 06/07/2025
1.CVA WITH RIGHT HEMIPERASIS
2.ATRIAL FIBRILLATION WITH CONTROLLED VENTRICULAR RATE
3.RIGHT INDIRECT REDUCIBLE INCOMPLETE INGUINAL HERNIA WITH OMENTUM AS HERNIATING CONTENT
4.K/C/O HTN, T2 DM SINCE 5 MONTHS


ECG ON 06/07/2025
TREATMENT
INJ. AMIODARONE 120 MG IV STAT
INJ. AMIODARONE 1MG/KG INFUSION OVER 6 HRS F/B. 0.5MG INFUSION NEXT 18 HRS
TAB. ECOSPRIN AV 75/20 MG PO HS
TAB. DABIGATRON 110 MG PO BD
TAB. TELMA 40 MG PO OD
TAB. GLIMI M1 PO OD
TAB. PAN 40 MG PO OD

DAY 4 ON EXAMINATION: 07/07/2025 at 8am
TEMP - 98.4 f
PULSE - 84/min irregularly regular
HEART RATE = 96/min
APEX PULSE DEFICIT - 12
BP - 120/90 mm of hg
RR - 20 / min
SPO2 - 98% on RA 
CVS -S1,S2 PRESENT, NO MURMURS 
RS - BAE -PRESENT , NVBS 
PA - SOFT , NON TENDER 
CNS - NFND 
GRBS - 130  mg/dl 
DIAGNOSIS ON 07/07/2025
1.CVA WITH RIGHT HEMIPERASIS
2.ATRIAL FIBRILLATION WITH CONTROLLED VENTRICULAR RATE
3.RIGHT INDIRECT REDUCIBLE INCOMPLETE INGUINAL HERNIA WITH OMENTUM AS HERNIATING CONTENT
4.K/C/O HTN, T2 DM SINCE 5 MONTHS
ECG ON 07/07/2025 6 AM
TREATMENT ON 07/07/2025 8 AM
INJ. AMIODARONE 120 MG IV STAT
INJ. AMIODARONE 1MG/KG INFUSION OVER 6 HRS F/B. 0.5MG INFUSION NEXT 18 HRS
TAB. ECOSPRIN AV 75/20 MG PO HS
TAB. DABIGATRON 110 MG PO BD
TAB. TELMA 40 MG PO OD
TAB. GLIMI M1 PO OD
TAB. PAN 40 MG PO OD

DISCHARGED ON 07/07/2025
Diagnosis
CEREBRO VASCULAR ACCIDENT WITH RIGHT HEMIPARESIS (ISCHAEMIC STROKE)
NON VASCULAR ATRIAL FIBRILLATION WITH CONTINUOUS VENTRICULAR RATE
K/C/O TYPE 2 DIABTETS MELLITUS AND HYPERTENSION SINCE 5 MONTHS
RIGHT INDIRECT INGUINAL HERNIA
Case History and Clinical Findings
CHIEF COMPLAINTS
C/O WEAKNESS OF RIGHT UPPERLIMB AND LOWER LIMB SINCE 3 DAYS
HISTORY OF PRESENTING ILLNESS
PATIENT WAS APPARENTLY ASYMPTOMATIC 3 DAYS AGO THE DEVELOPED WEAKNESS OF
RIGHT UPPER LIMB AND LOWER LIMB WEAKNESS SUDDEN ONSET , WHILE SLEEPING ON
BED
WEAKNESS IMPROVED NOW
NO H/O WEAKNESS OF OTHER LIMBS
NO H/O SLURRING OF SPEECH SINCE 3 DAYS
NO H/O DEVIATION OF MOUTH , LOSS OF VISION
H/O OF DIFFICULTY IN SWALLOWING
NO H/O SEIZURE LIKE ACTIVITY
NO H/O HEADACHE , GIDDINESS , NAUSEA , VOMITING.
NO H/O URINARY AND FECAL INCONTINENCE
H/O WEAK STRAEM OF URINE , DRIBBLING OF URINE
PERSONAL HISTORY:
MARRIED, NORMAL APPETITE,MIXED DIET ,REGULAR BOWEL AND BLADDER MOVEMENTS
,NORMAL MICTURITION ,NO ALLERGIES ,SLEEP ADEQUATE ,NO ADDICTIONS
FAMILY HISTORY: NOT SIGNIFICANT
GENREAL EXAMINATION: NO PALLOR ,ICTERUS, CYANOSIS,CLUBBIG ,
LYMPHADENOPATHY, MALNUTRITION
VITALS:-
TEMP: AFEBRILE, BP: 130/80 MMHG, RR: 16CPM, PR:76 BPM, SPO2: 98% AT RA.
SYSTEMIC EXAMINATION:- CVS- S1,S2 HEARD , NO MURMURS. RS- BAE+, NVBS. P/A: SOFT,
NON TENDER.
CNS :- HIGHER MENTAL FUNCTIONS INTACT, NO FOCAL NEUROLOGICAL DEFICIT
MRI WAS DONE ON 5/7/25 IMPRESSION- SMALL ACUTE INFARCT IN LEFT HEMIPONS
EXTENDING IN TO PONTOMEDULLARY JUNCTION
2D ECHO WAS DONE ON 5/7/25
IMPRESSION -MODERATE TR WITH PAH,MODERATE MR,MILD AR,TRIVIAL PR
RWMA +LAD HYPOKINESIS,NO AS/MS.CALCIFIED AV
MILD LV DYSFUNCTION +
GRADE II DIASTOLIC DYSFUNCTION ,NO PE,NO LV CLOT
Investigation
SEROLOGY -NEGATIVE
APTT TEST 32 Sec
BLEEDING TIME 2 Min 00 sec CLOTING TIME 4 Min 00 sec
HAEMOGLOBIN 13.4 gm/dl 13.0 - 17.0 Colorimetric LOX -PAPTOTAL COUNT 5,600 cells/cumm
4000 - 10000 ImpedenceNEUTROPHILS 50 % 40 - 80 Light MicroscopyLYMPHOCYTES 38 % 20 -
40 Light MicroscopyEOSINOPHILS 02 % 1 - 6 Light MicroscopyMONOCYTES 10 % 2 - 10 Light
MicroscopyBASOPHILS 0 % 0 - 2 Light MicroscopyPLATELET COUNT 2.11 lakhs/cu.mm 1.5-4.1
ImpedenceSMEAR Normocytic normochromic
HbA1c 6.5 %
Total Bilurubin 0.60 mg/dl 0 - 1 Jendrassic &Groff'sDirect Bilurubin 0.17 mg/dl 0.0 - 0.2 Jendrassic
&Groff'sSGOT(AST) 21 IU/L 0 - 35 Modified IFCCSGPT(ALT) 11 IU/L 0 - 45 Modified
IFCCALKALINEPHOSPHATASE211 IU/L 56 - 128 PNPP-DEATOTAL PROTEINS 6.3 gm/dl 6.4 - 8.3
BiuretALBUMIN 3.86 gm/dl 3.2 - 4.6 BCGA/G RATIO 1.58
 UREA 23 mg/dl 17 - 50 Urease-GLDHCREATININE 0.8 mg/dl 0.8 - 1.3 Modified Jaffe'sURIC ACID
4.0 mmol/L 3.5 - 7.2 Uricase-POD WithDHBSCALCIUM 10.0 mg/dl 8.6 - 10.2 Arsenazo
IIIPHOSPHOROUS 3.7 mg/dl 2.5 - 4.5 Direct UV withoutreductionSODIUM 137 mmol/L 136 - 145 Ion
SelectiveElectrodePOTASSIUM 3.4 mmol/L. 3.5 - 5.1 Ion SelectiveElectrodeCHLORIDE 98 mmol/L
98 - 107
Prothrombin Time 16 Sec 10-16secINR 1.11Total Bilurubin 0.58 mg/dl 0 - 1 Jendrassic &Groff'sDirect
Bilurubin 0.17 mg/dl 0.0 - 0.2 Jendrassic &Groff'sSGOT(AST) 17 IU/L 0 - 35 Modified
IFCCSGPT(ALT) 11 IU/L 0 - 45 Modified IFCCALKALINEPHOSPHATASE177 IU/L 56 - 128 PNPPDEATOTAL PROTEINS 5.2 gm/dl 6.4 - 8.3 BiuretALBUMIN 3.16 gm/dl 3.2 - 4.6 BCGA/G RATIO 1.55
UREA 20 mg/dl 17 - 50 Urease-GLDHCREATININE 0.7 mg/dl 0.8 - 1.3 Modified Jaffe'sURIC ACID
4.0 mmol/L 3.5 - 7.2 Uricase-POD WithDHBSCALCIUM 9.3 mg/dl 8.6 - 10.2 Arsenazo
IIIPHOSPHOROUS 3.4 mg/dl 2.5 - 4.5 Direct UV withoutreductionSODIUM 138 mmol/L 136 - 145 Ion
SelectiveElectrodePOTASSIUM 3.6 mmol/L. 3.5 - 5.1 Ion SelectiveElectrodeCHLORIDE 99 mmol/L
98 - 107
Treatment Given(Enter only Generic Name)
TAB.ECOSPRIN AV 75MG/20MG PO/HS 0-0-1
TAB PANTOP 40MG PO/OD/BBF
TAB TELMA 40MG PO/OD 1-0-0
TAB GLIMI M1 PO/OD 1-0-0
TAB DABIGATRAN 110MG PO/BD 1-0-1
TAB.METOPROLOL 25MG PO/OD 1-0-0
Advice at Discharge
TAB.ECOSPRIN AV 75MG/20MG PO/HS 0-0-1 XTO BE CONTINUED
TAB PANTOP 40MG PO/OD/BBF X5DAYS
TAB TELMA 40MG PO/OD 1-0-0 XTO BE CONTINUED
TAB GLIMI M1 PO/OD 1-0-0 XTO BE CONTINUED
TAB DABIGATRAN 110MG PO/BD 1-0-1 XTO BE CONTINUED
TAB.METOPROLOL 25MG PO/OD 1-0-0 XTO BE CONTINUED
Follow Up
REVIEW GM OPD AFTER 2WEEK
When to Obtain Urgent Care
IN CASE OF ANY EMERGENCY IMMEDIATELY CONTACT YOUR CONSULTANT DOCTOR OR
ATTEND EMERGENCY DEPARTMENT.
Preventive Care
 AVOID SELF MEDICATION WITHOUT DOCTORS ADVICE,DONOT MISS MEDICATIONS. In case
of Emergency or to speak to your treating FACULTY or For Appointments, Please Contact:
08682279999 For Treatment Enquiries Patient/Attendent Declaration : - The medicines prescribed
and the advice regarding preventive aspects of care ,when and how to obtain urgent care have been
explained to me in my own language
SIGNATURE OF PATIENT /ATTENDER
SIGNATURE OF PG/INTERNEE
SIGNATURE OF ADMINISTRATOR
SIGNATURE OF FACULTY
Discharge Date
Date:7/7/25
Ward:AMC.





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